Home > Blog > Medicaid eligibility redeterminations will resume in 2023. The first redetermination cycle was completed on January 17, 2018. The Consolidated Appropriations Act, 2023 includes some rules to protect Medicaid enrollees and ensure transparency and accountability during the unwinding of the continuous coverage requirements. "Nobody who is eligible for Medicaid or the Childrens Health Insurance Program should lose coverage simply because they changed addresses, didnt receive a form, or didnt have enough information about the renewal process, Becerra said in a news release. States that take less than a full year to complete all redeterminations could trigger greater coverage losses among eligible individuals, because there will be less time to conduct outreach and boost administrative staff capacity. For more information about available subsidies or to get started with enrollment, visit HealthCare.gov. Many children will be eligible for CHIP and many adults will be eligible for Affordable Care Act (ACA) Marketplace or other coverage. Employer Health Plan Affordability Calculator, Medicaid redetermination and eligibility requirements, report a change in circumstances within 10 to 30 days, states will be able to resume Medicaid disenrollments starting April 1, 2023, HealthCare.gov is offering an unwinding special enrollment period, For people whose eligibility is based solely on, For people whose eligibility is based on income as well as assets (ie, enrollees who are 65 or older, blind, disabled, or receiving, If the state Medicaid agency receives updated information about an enrollees circumstances, they must promptly conduct an eligibility redetermination, even if its not time for the persons regular redetermination. So states are required to periodically redetermine enrollees eligibility, and disenroll those who no longer meet the eligibility guidelines. Each state has its own Medicaid eligibility requirements, so you cant just transfer coverage from one state to another, nor can you use your coverage when youre temporarily visiting another state. Medicaid Redeterminations After the COVID-19 Public Health - Certifi States are not required to follow up with enrollees who do not respond to a renewal request; however, sending reminder notices via mail and also by phone, text, and/or email can reduce the number of people who remain eligible but are disenrolled at the end of the public health emergency because they did not respond to a request for information. At the end of 2022, the federal spending package by Congress included a provision that uncoupled the Medicaid continuous enrollment with the COVID-19 public health emergency (PHE). How states are tracking Medicaid data as unwinding begins That will change as of April 2023.). HHS offers Medicaid redetermination help amid coverage losses. The process is called Medicaid Redetermination. If you have access to an employer-sponsored health plan, your loss of Medicaid coverage will trigger a special enrollment period that will allow you to enroll in the employer-sponsored plan. The insurer has been expanding its exchange footprint over the past few years, and is now the largest marketplace carrier, with 2.1 million policyholders in 27 states. This means that once a child is enrolled in Medicaid or CHIP, their coverage will continue, uninterrupted, for at least 12 months, unless the child moves out of the state, requests a disenrollment, or (when applicable) premiums are not paid for the coverage. Please provide your zip code to see plans in your area. Whether you need to renew coverage, explore other coverage options, or have general questions, we are here to help. And some states that also offer additional state-funded subsidies allow people with higher incomes to enroll year-round. Its estimated thatapproximately 15 million people may lose coverageduring the next year through the unwinding. Call us toll-free Monday through Friday 8 a.m. to 5 p.m. at877-999-6442. "I am deeply concerned with the number of people unnecessarily losing coverage, especially those who appear to have lost coverage for avoidable reasons that state Medicaid offices have the power to prevent or mitigate," Becerra wrote in a letter sent to governors Monday. For more information, visit the Michigan Department of Insurance and Financial Services Shopping for Health Insurance webpage. KFF conducted the 20th annual survey of states Medicaid and CHIP eligibility levels and enrollment and renewal policies in January 2022, with help from the Georgetown University Center for Children and Families. This should include an email address and cell phone number if you have them, as states are increasingly using email and text messages, as well as regular mail, to contact enrollees. And if youve moved or your contact information has changed since you first enrolled in Medicaid, make sure the state has your current contact information on file. States that plan to start renewals after February have until February 15 to submit these plans. Additional guidance from CMS is forthcoming on these requirements. This version of the Medicaid and CHIP Scorecard was released in December 2021. If you're enrolled, pay close attention to renewal notices from your state. We join our federal partners in agreeing that we need more help from healthcare providers, community advocates, clergy and employers, to help us overcome this central challenge in this historically unprecedented effort. Since COVID began in 2020, things may have changed for you, including where you live, or work, and how much you earn. Healthy Living. Eligibility redetermination packets to start being mailed to beneficiaries depending on renewal date. States will need Medicaid stakeholders such as UnitedHealthcare along with healthcare providers, federally qualified health centers, and other frontline groups to tackle redetermination . Medicaid redetermination is the process that states use to ensure that people who are enrolled in Medicaid are still eligible for Medicaid coverage. Lock For questions about purchasing a health plan on HealthCare.gov, visit Michigan.gov/HealthInsurance, or call the Michigan Department of Insurance and Financial Services (DIFS) at 877-999-6442, Monday through Friday from 8 a.m. to 5 p.m. More information about changes to food assistance and Medicaid benefits connected to the COVID-19 Public Health Emergency can be found at Michigan.gov/2023BenefitChanges. We didnt see that happen in 2020, thanks in large part to the availability of Medicaid and CHIP. The Health and Human Services Department announced new flexibilities for states to use during the Medicaid redeterminations process . There are subsidies in place that can help many Michiganders get a plan for less than $10 a month and there is free local enrollment help available that can help consumers select a plan that works for their needs and budgets. The Consolidated Appropriations Act, 2023 makes this option permanent for states, instead of just a five-year program. But the overall pace of Medicaid eligibility redeterminations and disenrollments will vary considerably from one state to another. A federal government managed website by theCenters for Medicare & Medicaid Services.7500 Security Boulevard Baltimore, MD 21244. The State Overviews provide resources that highlight the key characteristics of states Medicaid and CHIP programs and report data to increase public transparency about the programs administration and outcomes. Policy. Q&A: Medicaid redetermination - what providers need to know And an alarming 64% of Medicaid beneficiaries are unaware that it's taking place. Here are some examples of how states are tracking and monitoring data to help speed and complete the redetermination process. Under the prior rules, that would have meant that Medicaid eligibility redeterminations (and terminations) could have resumed as of June 2023. Health centers should be analyzing their Medicaid and self-pay patient data to help them plan for the increased demand for assistance the unwinding will generate. They will be able to mitigate more of the hit than some companies that arent as prevalent in the commercial market, he said. We have created a website - staycovered.ga.gov - that will be regularly updated with important news and resources. B-8200, Redetermination Cycles. . If your Medicaid coverage ends before the start date of your new Marketplace plan, you could have a lapse, so it is important to enroll in a new plan as soon as possible. A lock ( For people whose income has increased enough to make them ineligible for Medicaid, but still eligible for this special enrollment period, there will be more flexibility in terms of access to coverage. Call 509.444.8200 or 208.848.8300 and ask to schedule an appointment with a Patient Resources Coordinator. The requirement, a condition of states receiving enhanced federal Medicaid funding during the pandemic, has helped drive Medicaid and CHIP enrollment to a record 85 million people, an increase of 19.1 percent since the start of the pandemic. But if the answer is no, be prepared for a coverage termination notice at some point after the end of March 2023. Medicaid redeterminations have been on pause for more than two-and-a-half years to enable people to remain covered during the COVID-19 pandemic. Medicaid. KFF Headquarters: 185 Berry St., Suite 2000, San Francisco, CA 94107 | Phone 650-854-9400 Washington Offices and Barbara Jordan Conference Center: 1330 G Street, NW, Washington, DC 20005 | Phone . This will be the case, for example, for someone who was enrolled under Medicaid expansion guidelines (which only apply through age 64) and has turned 65 during the PHE. As we enter the Medicaid unwinding process following the public health emergency (PHE) prompted by the COVID-19 pandemic, governance remains the same. Dont panic, but also dont delay, as your opportunity to enroll in new coverage will likely be time-limited. Click here to submit a Letter to the Editor, and we may publish it in print. Opens in a new window. Medicaid Redetermination - State of Michigan Pharmacies and community-based organizations will also be allowed to assist those who lost coverage due to administrative reasons with reenrollment. The main point to keep in mind is that the opportunity to transition to new coverage, from an employer, Medicare, or through the marketplace, is time-limited, although the unwinding SEP described above (announced in late January 2023) gives people significantly more flexibility in terms of being able to enroll in a plan through HealthCare.gov after losing Medicaid during the 16-month window that starts March 31, 2023. (Many states have continued their regular Medicaid eligibility redetermination processes throughout the pandemic, but they have not been able to disenroll people who are determined ineligible or who didnt respond to renewal information requests. they are still eligible but coverage is discontinued because they dont complete the renewal process). Eligibility redetermination actions began in April 2023, with a 12-month plan to return to normal operations. Herstate health exchange updatesare regularly cited by media who cover health reform and by other health insurance experts. The primary things to keep in mind: Your Medicaid coverage will continue if you continue to meet the eligibility guidelines and submit any necessary documentation as soon as its requested by the state. the extra cost that states have incurred to cover the FFCRA-related enrollment growth. This is true regardless of if one receives Regular State Plan benefits, long-term home and community based services (HCBS) via a Medicaid Waiver, or are on Nursing Home Medicaid. Status of State Medicaid Expansion Decisions: Interactive Map Click here for more details or to update your contact information. Millions of patients and their healthcare providers face challenges as State Medicaid agencies unwind coverage rules enacted as part of the COVID-19 public health emergency (PHE) that ended in April, 2023. Under the Consolidated Appropriations Act, 2023, all states will have to provide 12 months of continuous coverage for children deemed eligible for Medicaid or CHIP, even if the family has a change in circumstances before that 12-month period is up. States that prioritize re-checking the status of people who no longer appear to be eligible will likely generate coverage disruptions sooner than states that wait until enrollees standard renewal date arrives. KFF Headquarters: 185 Berry St., Suite 2000, San Francisco, CA 94107 | Phone 650-854-9400 Medicaid Redetermination Has Started On April 1, 2023, the state of Georgia must redetermine eligibility for all people who currently receive Medicaid or PeachCare for Kids coverage. Under normal circumstances, they would have lost their Medicaid eligibility upon turning 65, as the Medicaid eligibility rules are much different (and include asset tests) for people 65 and older. Also, 35 states say they will follow-up on returned mail via telephone, email, and text before terminating an enrollees coverage. How our department monitors insurance market practices, Insurance Company Contract and Rate Filings. State Medicaid Redetermination Plans. This may occur because of administrative barriers (i.e., old contact information or missing deadlines to submit information to determine eligibility). The most recent federal spending bill ended Medicaid coverage protections, which means Indiana Medicaid is returning to normal operations. Medicaid Renewals / Redeterminations: Process & Frequency Its not a requirement that states offer 12 months of postpartum coverage, but its likely that more states will offer this now that the program has been made permanent. LANSING, Mich. - Medicaid beneficiaries will have to renew their coverage this year, starting in June, as Michigan resumes Medicaid eligibility redeterminations to comply with federal legislation. In a May 2022 letter to governors, HHS noted We strongly encourage your state to use the entire 12-month unwinding period to put in place processes that will prevent terminations of coverage for individuals still eligible for Medicaid as your state works through its pending eligibility actions.. The American Rescue Plan gave states the option to offer 12 months of postpartum Medicaid coverage, instead of having the mothers coverage end two months after the baby is born, but this provision was only valid for five years. Medicaid is jointly run by the federal and state governments, so states have some leeway to set their own Medicaid rules. This approach may help protect patients from losing coverage due to administrative reasons. Many consumers may worry that buying their own health plan will be too difficult or too expensive. If you dont have access to an employer-sponsored plan and you are eligible for marketplace subsidies (most people are), the best course of action is to enroll in a marketplace plan as soon as you know that your Medicaid coverage will be terminated, in order to avoid or minimize a gap in coverage. A locked padlock What if buying health insurance is too expensive or too difficult for me? For the first quarter of 2023, states will continue to get the 6.2 percentage point boost that theyve been receiving throughout the pandemic. The Kaiser Family Foundation estimates that 5.3 to 14.2 million people will lose Medicaid coverage as the . States must use the U.S. Post Offices change of address database and/or state department of health and human services data to ensure that enrollees current contact information is on file with the state Medicaid office. When I change from Medicaid to a different type of health insurance, such as a Marketplace plan, will I have to change doctors? HHS projects that nearly 8% of current Medicaid enrollees will lose their coverage despite continuing to be eligible once eligibility redeterminations resume. Forty-one states have the data systems necessary to report the share of people who are disenrolled because they are determined to be ineligible versus the share who are disenrolled for procedural reasons. Medicaid is a prime example: As of late 2022, enrollment in Medicaid/CHIP stood at nearly 91 million people, with more than 19 million new enrollees since early 2020. Learn more. You may have to submit documentation to the state to prove your ongoing eligibility, so pay close attention to any requests for information that you receive. Millions in the U.S. May Lose Medicaid Coverage. Here's How to Prepare Under the previous rules, established by the Families First Coronavirus Response Act, states would have been allowed to start redetermining Medicaid eligibility after the end of the month that the PHE ended. And the Consolidated Appropriations Act, 2023 provides for the additional federal Medicaid funding to gradually decrease throughout 2023, instead of ending abruptly at the end of the quarter in which the PHE ends. Medicaid Members - Stay Informed. Stay Covered. Health centers serve over 30 million patients, including one in five Medicaid beneficiaries and one in three people living in poverty. As a result, some people may lose their Medicaid or CHIP coverage, but you still have other options. HHS projects that about 15 million people could lose their Medicaid eligibility once disenrollments resume starting in April 2023. But the continued enrollment growth in Medicaid is primarily due to the fact that the Families First Coronavirus Response Act (FFCRA), enacted in March 2020, has been providing states with additional federal funding for their Medicaid programs, as long as they dont disenroll people from Medicaid during the COVID public health emergency (PHE) period. But if not, the state will send the enrollee a request for more information. Successfully transitioning such individuals into other coverage options could reduce the number who become uninsured. Many states have continued to send out these renewal notifications and information requests throughout the pandemic (nearly all states have been conducting automatic (ex parte) renewals when possible, and more than half the states have also been sending renewal forms to enrollees). A state-by-state guide to Medicaid expansion, eligibility, enrollment and benefits. Medi-Cal also attempts to verify your information electronically so you may be found eligible for benefits without ever having to provide paper verifications. Available guidance can be found onMedicaid.gov. The new rules give states a clear time frame: They can begin to initiate the renewal/redetermination process as early as February 1, 2023 (states can start this in February, March, or April), and disenrollments can be effective as early as April 1, 2023 if adequate notice is given to the enrollee. But our goal today is to help you understand what you need to know in order to maintain coverage if youre one of the millions of people who could potentially lose Medicaid eligibility in the coming months. It is estimated that around 15 million Medicaid/CHIP members will be disenrolled between April 2023 and May 2024; while many have or are expected to transition to . Coverage options if youre no longer eligible for Medicaid. Also available are other recent KFF analyses related to the end of the public health emergency, including Unwinding of the PHE: Maintaining Medicaid for People with Limited English Proficiency and Without Build Back Better, Will the End of the Public Health Emergency Leave Even More People Uninsured? Medicaid Redetermination | HFS - Illinois If youve recently submitted renewal information to your state and its clear that youre still eligible, your coverage will continue as usual until your next renewal period. Across the 20 states that were able to report such data, about 13 percent of Medicaid enrollees are expected to be disenrolled when the continuous enrollment requirement ends. If youre currently enrolled in Medicaid, its a good idea to familiarize yourself with your states eligibility rules, and figure out whether youd be eligible if you were to apply today, with your current circumstances and income. Continuing to process these renewals now can help to maintain coverage and reduce backlogs at the end of the public health emergency. States and Healthcare Organizations Prep for Medicaid - Insider Laboratory. But they could choose to do so, and could also choose to waive premiums for CHIP during that time. DIFS Prohibition Orders for Consumer Finance and Credit Union. Free or nearly free coverage will be available in the marketplace for people eligible for this special enrollment period (this is a result of the American Rescue Plans subsidy enhancements). Almost all states (46) are planning to try to update enrollees mailing addresses, including through conducting data matches with the U.S. February 01, 2023 - On April 1, 2023, states will begin the Medicaid redetermination process as part of the public health emergency unwinding. If the PHE ends in April 2023, the FFCRAs rules would have resulted in the additional federal Medicaid funding (6.2 percentage points added to a states regular federal Medicaid funding) ending altogether at the end of June 2023. The need to complete a renewal form to see if you/your family still qualifies for Medicaid. Qualifying for Medi-Cal is now simpler than ever. As a result, millions of people who no longer qualify for Medicaid will lose their Medicaid coverage. Starting in April 2023, states will begin disenrolling millions from their Medicaid rolls. Its important to respond to these notices, as coverage will be terminated if requested documentation is not provided. Were hopeful that states will work to make the redeterminations and renewals process as transparent, accurate, and simple as possible. Healthier People Through Healthier Markets, Medicare + Fraud, Waste, and Abuse Training, 2023 Consumer Experience & Digital Health Forum, Moving from Medicaid to Employer-Provided Coverage, Moving from Medicaid to Marketplace Coverage, Pasar de Medicaid a Una Cobertura Proporcionada por Un Empleador, Pasar de Medicaid a la Cobertura del Mercado. As of September 2022, over 90 million people across the country were enrolled in Medicaid and CHIP. We have operational protocols in place with member outreach in the states that allow through text, phone and mail to help members reestablish eligibility, CEO Joseph Zubretsky said during a call with investors at the time. For comparison, there was 70.9 million individuals enrolled in March 2020. In the second quarter, that will drop to 5 percentage points. Washington Offices and Barbara Jordan Conference Center: 1330 G Street, NW, Washington, DC 20005 | Phone 202-347-5270, www.kff.org | Email Alerts: kff.org/email | facebook.com/KFF | twitter.com/kff. The federal government offered states extra financial support for Medicaid on the condition that they not remove people from the rolls even if their incomes rose above eligibility standards. It is important to note that states beginning renewals in February must submit renewal redistribution plans andsystem readiness artifactsby February 1. NACHC is looking to partner with and uplift the incredible work that health center leaders are doing to protect Medicaid and CHIP patients. How States Can Prepare for 2023 Medicaid Redeterminations Medicaid Redetermination Consumers Insurance Health Insurance Medicaid Redetermination Nationwide, Medicaid beneficiaries will have to renew their coverage starting this year to comply with federal legislation. States will have up to 12 months toinitiateand 14 months tocompletea renewal for all individuals in Medicaid, CHIP, and the Basic Health Program. Send us an email at DIFSInfo@michigan.gov, Department of Insurance and Financial Services, Additional Financial and Insurance Services Forms. Fax the documents to 1-866-661-7025 and keep a copy of the fax confirmation. Before selecting a new plan, it is important to research which plans include your doctors in their network to make sure that the providers you prefer and services you need are covered under that plan. Official websites use .gov Over 1 million Americans lose Medicaid over paperwork | Fortune The year-end spending package does not change this timeline. This version of the Medicaid and CHIP Scorecard was released . Secure .gov websites use HTTPS Can you appeal your states decision to disenroll you? President Biden's Consolidated Appropriations Act of 2023 allows Medicaid eligibility terminations to begin on April 1, 2023, resulting in far-reaching Medicaid redeterminations. All of these terms mean the same thing, and refer to the process by which the state rechecks each year to see if an enrollee is still eligible for Medicaid. The recent 90-day extension of the PHE has no impact to this April 1st date. The pace and extent of disenrollment will vary by state. There is a relatively new special enrollment period that allows people with household income up to 150% of the poverty level to enroll in coverage year-round, for as long as the enhanced subsidies remain in place (so at least through the end of 2025, and possibly longer if Congress grants another extension). So states will be able to resume Medicaid disenrollments starting April 1, 2023. The company will lose $2 billion once redeterminations are complete, Wright said. In Massachusetts, the state invested $5 million in a community-based Medicaid redetermination and vaccination outreach campaign to communities hit hardest by the pandemic. For a person who is no longer Medicaid-eligible under normal rules, Medicaid coverage can end as early as April 1, 2023. on But even if you still qualify for Medicaid, you may need to take steps to verify your eligibility. Medicaid eligibility redeterminations will resume in 2023. Medicaid eligibility redeterminations will resume in 2023. Here's what Some people who will lose Medicaid eligibility are now eligible for Medicare instead. We are working closely with our state partners and our network of community partners in each market to facilitate member transition and coverage continuity, she said. With President Joe Biden's announcement that he would allow the federal public health emergency to lapse on May 11, states are free to resume redeterminations as soon as April 1.